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Medlink Georgia, Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Commerce, GA

NPI 1477068526 · NPPES record last updated Apr 3, 2023

Key facts

NPI
1477068526
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
MEDLINK GEORGIA, INC
Practice address
611 Hospital Rd
Commerce, GA 30529-1143
Phone
(706) 788-2127
Fax
(706) 788-2815
NPI assigned
Dec 12, 2017
Organization subpart
Yes
Parent organization (as reported)
MEDLINK GEORGIA, INC

Authorized official

Name
Dave Ward
Title
Ceo
Phone
(706) 788-3234

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Corporate family (same tax ID) 45

Organizations that report the same tax identification number in the National Provider Directory.

View all 45

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in GA

Federally qualified health center certification: CCN 111084

Legal name
MEDLINK GEORGIA INC
Doing business as
MEDLINK COMMERCE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 5, 2018
Last certification
Apr 5, 2018
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Feb 29, 1980 in GA
Enrollment address
611 Hospital Rd
Commerce, GA 30529-1143

All disclosed owners & managing parties 21

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
David Ward
Individual 		Corporate Officer
President and Ceo		 Jan 1, 2015
Christopher Gilley
Individual 		Corporate Officer
Cfo		 Jul 21, 2021
Linda Rame
Individual 		Corporate Director
Volunteer Community Board of Direct		 Sep 20, 2022
Dennis Kimbrell
Individual 		W-2 Managing Employee
Director of Pharmacy SVC		 Aug 5, 2017
Bobby Berryman
Individual 		Corporate Director Feb 22, 1999
Arthur Gorman
Individual 		W-2 Managing Employee
Director of Imaging		 Jan 3, 2022
Marilyn Favors
Individual 		Corporate Director Mar 19, 2009
Medlink Georgia Inc
Organization · Colbert, GA
Non-profit 		Operational/Managerial Control Feb 8, 2018 100%
Merlin Mejia
Individual 		Corporate Director
Volunteer Community Board of Direct		 Sep 17, 2019
Tyler Wallace
Individual 		Corporate Director
Volunteer Community Board of Direct		 Feb 20, 2024
Angelia R West
Individual 		W-2 Managing Employee
Director of Revenue Cycle MGMT		 Apr 1, 2013
Alexandra Duvall
Individual 		Corporate Director
Volunteer Community Board of Direct		 Sep 21, 2021
Joe Fernandez
Individual 		Corporate Director Jun 17, 2012
Douglas Bridges
Individual 		Corporate Director Jan 21, 1993
Gary Morris
Individual 		Corporate Director
Volunteer Community Board of Direct		 Oct 14, 2018
Nancy Lord
Individual 		Corporate Director Jan 21, 2017
Mushtaq Ahmed
Individual 		Corporate Officer
Chief Medical Officer		 Sep 1, 2016
Trisha Jones
Individual 		W-2 Managing Employee
Director of Nursing		 May 7, 2024
Cassandra Saffold
Individual 		Corporate Director Apr 18, 2017
John Barber
Individual 		Corporate Director
Volunteer Community Board of Direct		 Jul 19, 2022
Sherrie Stone
Individual 		W-2 Managing Employee
Director of Operations		 Mar 15, 2015

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Medlink Habersham
Demorest, GA · CCN 111975		 Federally qualified health center Operational/Managerial Control Jan 13, 2014
Medlink Monroe
Monroe, GA · CCN 111037		 Federally qualified health center Operational/Managerial Control (100%) Jun 5, 2023
Medlink Danielsville
Danielsville, GA · CCN 111049		 Federally qualified health center Operational/Managerial Control (100%) Jan 14, 2022
Medlink Winder Womens Center
Winder, GA · CCN 111050		 Federally qualified health center Operational/Managerial Control (100%) Nov 1, 2016
Medlink Jefferson
Jefferson, GA · CCN 111141		 Federally qualified health center Operational/Managerial Control (100%) Mar 1, 2021
Medlink Suches
Suches, GA · CCN 851107		 Federally qualified health center Operational/Managerial Control (100%) Oct 20, 2021
Medlink Cleveland
Cleveland, GA · CCN 851100		 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2021
Medlink Georgia Inc
Cleveland, GA · CCN 111898		 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2022
Medlink Oconee
Watkinsville, GA · CCN 851834		 Federally qualified health center Operational/Managerial Control (100%) Apr 22, 2023
Medlink Athens
Athens, GA · CCN 851950		 Federally qualified health center Operational/Managerial Control (100%) Aug 3, 2023

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20180405001873 GA Part a Provider - Federally Qualified Health Center (FQHC) 3274442850 Practice locations: Commerce, GA

National Provider Directory

Tax ID family
Oglethorpe Family Medic (46 organizations share this tax ID)
Part of
Oglethorpe Family Medic

Locations

613 Hospital Rd
Commerce, GA 30529
Phone (706) 335-9411

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

611 Hospital Rd
Commerce, GA 30529-1143

Mailing address

PO Box 459
Colbert, GA 30628-0459
Phone (706) 788-3234

Other names

  • MedLink Commerce Doing business as

Other providers in Commerce, GA

All providers in Commerce, GA · Federally Qualified Health Center (FQHC) in Georgia

Sources for this page

Verify at the official NPI Registry.